MahlstedtMotivation Health and Nutrition Assessment Question Title * 1. Which of these areas could you use support with? (Select all that apply.) Emotional Eating & Family Habits Energy, Performance & Strength Anti-Aging, Sleep, & Restorative Health Digestive Health & Immune System Support Nutrition & Cleansing Accountability & Mindset Brain Health & Body Balance Question Title * 2. Which describes your mind and brain function? Do you feel tired and slow all the time? Do you feel foggy and confused at times? Do you feel periods of clarity with moments of mental exhaustion? Do you feel clear but desire to support brain health? Question Title * 3. Are you experiencing discomfort in your body (aches and pains)? Yes No Question Title * 4. Are you equivalent to your age? I look and feel my age. I look and feel younger than my age. I look and feel older than my age. Question Title * 5. How is your mind and brain function? I feel tired and foggy all the time. I feel foggy and unmotivated I feel periods of clarity with moments of mental exhaustion. I feel clear a majority of the time. I feel clear but desire to support my brain health. Question Title * 6. Do you take vitamins daily? Totally Vitamins? Do I need those? Question Title * 7. How is your eating? I eat healthy more often then not. I try to eat healthy, but binge on sweets or junk food. Define healthy... Nothing with a heartbeat please. Vegan in the house! Question Title * 8. Have you ever done a cleanse? No. 1 time a year. 2 times a year. Multiple times a year. Question Title * 9. Rate your stress level. Back up, I'm about to lose my shit! I save my meltdowns for behind closed doors. Sure I'm a little stressed, but who isn't? Welcome to the Zen Den. Question Title * 10. Name & Contact Info Done